American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Apr 1979
Changing obstetric practices and amelioration of perinatal outcome in a university hospital.
A 40 year review of obstetric statistics revealed that the perinatal outcome has improved significantly following the introduction of biophysical and biochemical fetal surveillance systems. A simultaneous increase in the cesarean section rate is noted; however, this increase in the cesarean section rate is not related to an increase in the diagnosis of fetal distress. Other factors which may influence an improved perinatal outcome have been examined. It is concluded that biochemical and biophysical fetal surveillance has played a decisive role in the improvement of perinatal results.
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Chronically instrumented, near-term pregnant sheep were subjected to autonomic blockade with spinal anesthesia. Systemic arterial pressure, heart rate, and uterine blood flow decreased and uterine vascular resistance increased during the spinal blockade. Infusion of dopamine during the spinal hypotension corrected the disturbed circulatory parameters. These data provide evidence that: (1) the peripheral circulation of the near-term pregnant sheep is as sensitive as that of pregnant women to autonomic blockade, (2) the sensitivity is probably related to factors other than the changes in venous pressure in areas below the pelvis, and (3) dopamine represents a useful agent in the management of spinal hypotension.
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This study was designed to re-evaluate neonatal condition at birth following elective cesarean section performed with epidural anesthesia and a modified technique of general anesthesia. Two groups of 20 patients were studied. Twenty received epidural anesthesia with 2 per cent lidocaine-carbon dioxide-epinephrine, and 20 patients were given general anesthesia. ⋯ No significant differences in oxygen tension and acid-base balance in umbilical venous and arterial blood were demonstrated between the two sets of neonates. One-and five-minute Apgar scores and time to sustained respiration were similar in both groups. Our observations of the infants immediately after delivery led us to conclude that either anesthesia technique is acceptable for elective cesarean section.
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Am. J. Obstet. Gynecol. · Dec 1978
Resident training goals in obstetrics and gynecology for the 1980's. Presidential address.
Residency training goals and manpower needs in the 1980's and beyond should bear a consistent relationship. Projections for supply and demand for obstetrics and gynecology and for those medical specialties with overlapping responsibilities, though fraught with uncertainties, suggest that currently approved training programs in obstetrics and gynecology will meet clinical manpower needs for 1990. ⋯ The popular and pervasive emphasis on primary care carries with it the serious risk that the present shortage of qualified investigators may not be corrected in the next decade. This could seriously hamper our efforts to recruit new faculty and maintain quality in our training programs.